320149 12/28/17 o��u`��p"•, CITY OF CARMEL, INDIANA VENDOR: 355765
• d `�•: ONE CIVIC SQUARE ARCTIC ZONE LLC CHECK AMOUNT: $****49,796.04*
?_ _� CARMEL, INDIANA 46032 1040 3RD ACE SW CHECK NUMBER: 320149
v CARMEL IN 45032 CHECK DATE: 12128/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4350900 100809 1 275.33 EST RINK EXPENSE MGMT
902 435,0900 100809 1010218 970.02 EST RINK EXPENSE/MGMT
902 4350900 100809 112117-1 10,000.00 EST RINK EXPENSE/MGMT
902 4350900 100809 112117-2 3,211.00 EST RINK EXPENSE/MGMT
902 4350900 100809 112117-3 208.08 EST RINK EXPENSE/MGMT
902 4350900 100809 112117-4 1,912.00 EST RINK EXPENSE/MGMT
902 4350900 100809 2 222.56 EST RINK EXPENSE/MGMT
902 4350900 100809 2570 15,000.00 EST RINK EXPENSE/MGMT
902 4350900 100809 2571 1,494.79 EST RINK EXPENSE/MGMT
902 4350900 100809 2572 10,723.82 EST RINK EXPENSE/MGMT
902 4350900 100809 2574 413.74 EST RINK EXPENSE/MGMT
902 4350900 100809 2575 245.82 EST RINK EXPENSE/MGMT
902 4350900 100809 2576 325.90 EST RINK EXPENSE/MGMT
902 4350900 100809 2577 332.52 EST RINK EXPENSE/MGMT
902 4350900 100809 2606 398.95 EST RINK EXPENSE/MGMT
902 4350900 100809 3 41.05 EST RINK EXPENSE/MGMT
902 4350900 100809 4 147.02 EST RINK EXPENSE/MGMT
902 4350900 100809 456005-1 156.71 EST RINK EXPENSE/MGMT
902 4350900 100809 5 229.72 EST RINK EXPENSE/MGMT
902 4350900 100809 702041 3,487.01 EST RINK EXPENSE/MGMT
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355765 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ARCTIC ZONE LLC IN SUM OF$ CITY OF CARMEL
1040 3RD ACE SW An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CARMEL, IN 46032
Payee
$49,796.04
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Redevelopment Commission Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100809 1 43-509.00 $275.33 1 hereby certify that the attached invoice(s),or 11/17/17 1 Admission expenses $275.33
902 902 902 902
100809 702041 43-509.00 $3,487.01 bill(s)is(are)true and correct and that the 11/21/17 112117-1 Ice Rink operations $10,000.00
902 902 materials or services itemized thereon for 902 1 902
100809 112117-4 43-509.00 $1,912.00 11/21/17 112117-4 Lockers for customers and volunteers $1,912.00
902 902 which charge is made were ordered and 902 902
100809 456005-1 43-509.00 $156.71 received except 11/21/17 1010218 Logo for ice $970.02
902 902 902 902
100809 1010218 43-509.00 $970.02 11/21/17 702041 Jackets and caps for Ice Rink employees $3,487.01
902 902 902 902
100809 112117-3 43-509.00 $208.08 11/21/17 456005-1 Tools for rink $156.71
902 902 902 902
100809 112117-2 43-509.00 $3,211.00 11/21/17 112117-3 Wrist bands for skating sessions $208.08
902 902 Tuesday, December 19,2017 902 902
100809 112117-1 43-509.00 $10,000.00 11/21/17 112117-2 Additional ice skates $3,211.00
902 902 902 902
100809 5 43-509.00 $229.72 11/24/17 2 Admission expenses $222.56
902 902 yn f� 902 902
100809 4 43-509.00 $147.02 11/24/17 4 Admission expenses $147.02
902 902 902 902
100809 2 43-509.00 $222.56 '� 11/24/17 I 5I Admission expenses I $229.72
902 902 902 902
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
, 20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355765 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ARCTIC ZONE LLC IN SUM OF$ CITY OF CARMEL
1040 3RD ACE SW An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CARMEL, IN 46032
Payee
$49,796.04
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Redevelopment Commission Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# . INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100809 3 43-509.00 $41.05 11/24/17 3 Admission expenses $41.05
902 902 902 902
100809 2571 43-509.00 $1,494.79 , 12!7/17 2571 Radios,headsets,and chargers for ice rink $1,494.79
902 902 902 902 staff
100809 2570 43-509.00 $15,000.00 12/7/17 2570 Management fee for December $15,000.00
902 902 902 902
100809 2575 43-509.00 $245.82 12/8/17 2572 Reimbursement of payroll expenses $10,723.82
902 902 902 902
100809 2572 43-509.00 $10,723.82 l 12/8/17 2575 Propane gas for Olympia $245.82
902 902 902 902
100809 2576 43-509.00 $325.90 12/8/17 2576 Wristbands for skating sessions $325.90
902 902 902 902
100809 2574 43-509.00 $413.74 a( 12/8/17 2574 Rubber mats $413.74
902 902 902 902
100809 2577 43-509.00 $332.52 12/9/17 2577 Supplies for ice rink staff $332.52
902 902 902 902
100809 2606 43-509.00 $398.95 12/14/17 2606 Supplies for ice rink staff $398.95
902 902 902 902
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
, 20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
1 AWCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2576
1040 3rd Ave. S.W.
I nvo ice Date: Dec 8,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN_ Net 1st of Next Month
Sales Rep.ID Shipping.Method Ship'Date Due Date
Courier 1/1/18
Quantity Item 'Description Unit Price : Amount
1.00 Wristband for skating sessions 325.90 325.90
Subtotal 325.90
Sales Tax
Total Invoice Amount 325.90
Check/Credit Memo No: Payment/Credit Applied
"'TOTAL, 325.90
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
loeBuilders;Supply, Inc
4628 Crossroads Park Dr
Liverpool, NY 13088
Phone: 315-413-0200 M A& �JOJLW
Fax:315-413-0517
ICESUILDERS www-icebuilders.com C&O'NFIR Ar-Ma
Quote Number: 4511
Quote Date: Nov 14,2017
Page:
Carmel Ice Skatium Carmel Ice Skatium
1040 3rd.Ave.SW. 1040 3rd.Ave.SW.
Carmel, IN 46032 Carmel, IN 46032
ATTN:
P-315 413-0200 F.315 41 3-051 7
Customer,
u,
CAR1 20 12/14/17 Net 25 Days
10-00 80230 Risport 103 Fig.-01 child 63.00
630.00
10-00 80231 Risport 103 Fig.-02 child
63.00 630.00
1.00 80233 Risport 103 Fig.-04 child 63.00 63.00
10-00 80239 Risport 103 Fig.- 10 Adult 63.00 630.00
5.00 80240 Risport 103 Fig.-11 Adult 63.00 315.00
5.00 80241 Risport 103 Fig.- 12 Adult 63.00 315.00
5.00 80242 Risport 103 Fig.- 13 Adult 63.00 315.00
1.00 80253 Risport 203 Hock.-9 adult 63.00 63.00
Subtotal 2,961.00
Notes: Freight 250.00
•Price does not include any applicable sales use taxes(unless noted above) Sales Tax
•Price does not include freight cost;they will be prepaid and added W the invoice(unless
noted above)
•Price does not include installation(unless noted above)
•We donot make representation or warranties on product installation for material only
sales
>-The undersigned agrees W pay all costs of collection,including all reasonable attorney's Signed by:
fees,court costs and other expenses Incurred bylceBuilders Supply,Inc. Anycontroversy
or claim arising out of this contract shall be venued in the County of Onondaga,Now York. Company:
Any past due invoices will carry an interest charge of 18%per annum.
>Changes or cancellations are subject to a 250%restocking fee Date:
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2575
1040 3rd Ave. S.W.
Invoice Date: Dec 8,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment'Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method, , Ship Date Due Date
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Propane Gas for Olympia 245.82 245.82
Subtotal 245.82
Sales Tax
Total Invoice Amount 245.82
Check/Credit Memo No: Payment/Credit Applied
TOTAL 245.82
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2574
1040 3rd Ave. S.W.
Invoice Date: Dec 8,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terns
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Rubber Matting for Skate Rental Counter. (ordered per Tricia 413.74 413.74
Didn't need 3 rolls ,we will use other 2 at Skadium)
Subtotal 413.74
Sales Tax
Total Invoice Amount 413.74
Check/Credit Memo No: Payment/Credit Applied
TOTAL 413.74
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2572
1040 3rd Ave. S.W.
Invoice Date: Dec 8,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
Bill To: Ship to:
ICEAT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Payroll thru 11/24 (regular hours$2793.20, overtime hours 4,411.15 4,411.15
$917.46, payroll tax$700.49)
1.00 Payroll thru 12/8 excluding December tax(regular hours 6,312.67 6,312.67
$5474.62,overtime hours $838.06)
Subtotal 10,723.82
Sales Tax
Total Invoice Amount 10,723.82
Check/Credit Memo No: Payment/Credit Applied
TOTAL 10,723.82
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
1=
ICE AT CENTER GREEN PAYROLL
Payroll Regular OT Total
11/24/2017 $2,793.20 $917.46 $3,710.66
Payroll Tax November $700.49
12/8/2017 $5,474.621 $838.051$6,312.671
r ,
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 1
1040 3rd Ave. S.W.
Invoice Date: Nov 17,2017 Carmel, IN 46032 Page: 1
Duplicate
Voice:
Fax:
Bill To:' Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID D. Customer'PO -'. Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship'Date :• Due Date ,
Courier 12/1/17
.Quantity Item Description Unit Price Amount,
1.00 Admission Expenses(storage drawers,gloves, hangars,door 275.33 275.33
latches,door locks$275.00)Menards
Subtotal 275.33
Sales Tax
Total Invoice Amount 275.33
Check/Credit Memo No: Payment/Credit Applied
TOTAL 275.33
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 3
1040 3rd Ave. S.W.
Invoice Date: Nov 24,2017 Carmel, IN 46032 Page: 1
Duplicate
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID, Shipping Method Ship Date Due Date
Courier 12/1/17
Quantity Item Description Unit Price Amount
1.00 Admission Expenses(trash cans,tickets, pens$41.05) 41.05 41.05
Staples
Subtotal 41.05
Sales Tax
Total Invoice Amount 41.05
Check/Credit Memo No: Payment/Credit Applied
TOTAL 41.05
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 5
1040 3rd Ave. S.W.
Invoice Date: Nov 24,2017 Carmel, IN 46032 Page: 1
Duplicate
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID , °Customer PO, Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 12/1/17
Quantity Item Description Unit Price . Amount
1.00 Admission Expenses(floor mats, Bandaids, Lysol, first aid 229.72 229.72
kits, rubber gloves, clip boards$229.72)Sams Club
Subtotal 229.72
Sales Tax
Total Invoice Amount 229.72
Check/Credit Memo No: Payment/Credit Applied
TOTAL 229.72
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 4
1040 3rd Ave. S.W.
Invoice Date: Nov 24,2017 Carmel, IN 46032 Page: 1
Duplicate
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID" Shipping Method Ship Date Due Date
Courier 12/1/17
Quantity Item Description Unit Price Amount
1.00 Admission Expenses(hangar hook, stools, table, bank bags, 147.02 147.02
dry erase board, dry erase pens,tickets$147.02)Office
Max/Target
Subtotal 147.02
Sales Tax
Total Invoice Amount 147.02
Check/Credit Memo No: Payment/Credit Applied
TOTAL 147.02
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2
Invoice Date: Nov 24,2017
1040 3rd Ave. S.W. Page: 1
Carmel, IN 46032
Duplicate
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID. Customer PO Payment"Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep-1D Shipping Method Ship Date Due Date.
Courier 12/1/17
Quantity Item Description Unit Price Amount
1.00 Sams Club (Hand Warmers for Resale$119.84), Walmart( 222.56 222.56
Gloves for Resale$102.72)
Subtotal 222.56
Sales Tax
Total Invoice Amount 222.56
Check/Credit Memo No: Payment/Credit Applied
TOTAL 222.56
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC ANVOICE
CARMEL ICE SKADIUM Invoice Number: 2570
1040 3rd Ave. S.W.
Invoice Date: Dec 7,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
:Bill To Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer lD Customer.POI Payment Terns
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 1/1/18
Quantity Item `Description' Unit Price Amount
1.00 Management Fee December 15,000.00 15,000.00
Subtotal 15,000.00
Sales Tax
Total Invoice Amount 15,000.00
Check/Credit Memo No: Payment/Credit Applied f
TOTAL :. . .. " 15,000.00
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2571
1040 3rd Ave. S.W.
Invoice Date: Dec 7,2017
Page: 1
Carmel, IN 46032
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Ra dios,head sets and chargers for Staff use at Rink 1,494.79 1,494.79
Subtotal 1,494.79
Sales Tax
Total Invoice Amount 1,494.79
Check/Credit Memo No: Payment/Credit Applied
TOTAL 1,494.79
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2577
Invoice Date: Dec 9,2017
1040 3rd Ave. S.W. Page: 1
Carmel, IN 46032
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Hand Warmers for Resale (Sams Club$179.76) 179.76 179.76
1.00 Socks for Resale (Walmart$92.88) 92.88 92.88
1.00 Office Supply(Calculator Meijer$32.09) 32.09 32.09
1.00 Ice Resurfacer but tools Hose Nozzle, Power Strip,Tool 27.79 27.79
Organizer Ace Hardware$27.79)
Subtotal 332.52
Sales Tax
Total Invoice Amount 332.52
Check/Credit Memo No: Payment/Credit Applied
TOTAL 332.52
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
ARCTIC ZONE, LLC INVOICE
CARMEL ICE SKADIUM Invoice Number: 2606
1040 3rd Ave. S.W.
Invoice Date: Dec 14,2017 Carmel, IN 46032 Page: 1
Voice:
Fax:
Bill To: Ship to:
ICE AT CENTER GREEN ICE AT CENTER GREEN
Customer ID Customer PO Payment Terms
ICE AT CENTER GREEN Net 1st of Next Month
Sales Rep ID Shipping Method Ship Date Due Date -_
Courier 1/1/18
Quantity Item Description Unit Price Amount
1.00 Hydralic Belts for Olympia machine(AutoZone$27.71 ) 27.71 27.71
1.00 Office Supplies Office Max(Laminate, magnetic board$48.98) 48.98 48.98
1.00 Skate Rental supplies(Sams Club Broom,sanit¢er, lysol, 322.26 322.26
stapler,tape, pens$322.26)
Subtotal 398.95
Sales Tax
Total Invoice Amount 398.95
Check/Credit Memo No: Payment/Credit Applied
TOTAL , 398.95
Please make all checks payable to Arctic Zone, LLC
PAST DUE ACCOUNTS SUBJECT TO 1 1/2%SERVICE CHARGE PER MONTH.
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SALE 731�'�"R,',+�;a.i nE: Rd
GENERAL MERCHANDISECau'ino1,
7976717483 CALCULATOR 29.99 CT3i
TOTAL �� •1''- 'laky' '" ;? FLOYD JOHNSON
IN 7% Sales Tax 2.10 � EXT
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,..........E9Rq.�� 9.99
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TOTAL 32 09; ' 07932599996'
PAYMENTS ` , 5127543
Primary'Account '- "`pebi't" I GARAGE/TOOL ORG)VIIE:
ATM/DEBIT CARD TENDER 32.09
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SIGNATURE I LO'fl:i .J,IIW tI II
See back of receipt for Your chance
to Win $1000 I See back df'receipt for your chance
to,win $1000
ID #: 7L349LKBROB. I : "
7L33P7KBNYX
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Save mon@y..Live:bettej ; - '
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MANAGER KYLE.'LANGSTON ( 317 ) 844 - 0096
2001 E'151ST 'ST MANAGER,KYLE LANGSTON
CARMEL IN=46013 2001 1-451ST,-ST
ST# 01601. OP# 009049 TEN 49 TR# 09880. CARMEL IN 46033
GILDAN SOCKS`088309665661 ST# 01601 OP# 009049 TE# 49'TR#'.07914
'GILDAN SOCKS 088309656656 . ;: g:gg Xz GILDAN SOCKS 088309656648` ; ;;.9!.98 X
GILDAN SOCKS 088309665661 g g8 X I; GILDAN SOCKS 088309656648, -9.98 X,
GILDAN SOCKS 088309656648 9.98 X GILDAN SOCKS 088309656648. 9:98 X
SUBTOTAL 39 92 BOYS SOCKS 088309633816` '•'` 6.97 X
TAX 1 7:000,x` 2 ;79 GILDAN SOCKS 0883Q9656648. 9.98 X
TOTAL 42.71
SUBTOTAL-
-
UBTOTAL' 46 89
DEBIT ' TEND 42,71 TAX 1 7:000 % 3:28
CHANGE-DUE ' :0.00 J '.TO.TAL. .: 50::17
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DEBIT TEND 50.
CHANGE DUE 000.
EFT DEBIT PAY',FROM PRIMARY, . .
42.71' 'TOTAL PURCHASE
FIFTHTHIRD DEBIT * ' **x x*** 85g7 11 '.. EFT DEBIT PAY FROM PRIMARY
REF # .734306664285.. ' ` 50.17 TOTAL PURCHASE
'NETWORK 1D..0076 APPR -CODE`292313 r FIFTHTHIRD DEBIT *. **** *** 8597. I 1
REF. #'733700130178 :.
Debit k NETWORK ID. ;0076 APP;R CODE,788903
AID AOOOOOU0042203
TC 2D469A96AE7745D2 4 Debit
*NO SIGNATURE REQUIRED r AID A0000000042203.
TERMINAL-# SC010056 TC E8FEOB229508BAA2
*Pin Verified
`12/09/17 08:56:11`` TERMINAL # SC010056:,.
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TC# 4289 5254.,9283'8739:861.. 12/03/17 08:35:18
# ITEMS SOLD.5 .
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Low Pri 12%09/1 Can Trues You
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12/03/17 08:35.:25
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12/01/2017 6 OJ PM 506K4
Duralast Serpentine Belt, EA
SUBTOTAL 25.90
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TOTAL TAX @ 7TOTAL 21.
7.71
2P7T.QQAPMYQ5YR44W XXX.XXXXXXXXX8597 MASTERCARD 27.71
APPROVAL # 500382
Data Source: •CHIP
Sia 6595 1 69"1 792164 17 8;2 App Name6L'abel De:b.it/FIFTHTHIRROEBIT
SAL E P AID: A000000004Y203
535709 ;LAM NTD: PCH,LTR. _,.28 99"S e_ TC 1E6C385E19F3E4DB"
901403,_ SHEETS,MAGNETI . 16 79-S PIN Bypassed:
-:,,Su 45 78 i
DREG.#02 CSR #59 REOEIPT #195585
' INSt;ate:.Tax. .. 7% ' S T R . TRANS #91.:9.09,0
i �: -3 20 :, . 1 STORE- .40672
Total 48 98 []ATE 1. 2-'/ 1 3•,f 2 017 16':39 4
Cash: . 60,.00 # OF L:TEh1S,.;_ SOL,O.. ;2 ..
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Shop online a.f www offi,cedePot: Com :' PERSDNA`L. UARRANTY TNFORMATION
* * *** **** ** ,� *XXtx*******;*S DEMNARY_, " 'MATT:
i 335' NORTH BANCROFT
WE,WANT :TO;HEAR-.FROM YOU1. 462012`' =
( 317 ) 989 = 1161,
Participate in our online customer' : 2008 Monda .A.ccord E)<'
Item `'066.402 506K`*'V418BED BELT
survey and receive a coupon for.,., 1 YEAR/1�2 MONTH_41ARRANTY PERIOD'` '
$10 off sour next quallfain9 2008 Honda Accord ER:_
Purchase of $50 or'more on Item: D65402--506K4 'U=RIBBED BELT- D�
.1 YEARY-12 -MONTH -UARRANTY PERIOD -----
office supplies; furniture and more. i Limited Warranty
(Excludes TechnolosluLam'•t 1. coupon Per If a "Part fails during the warranty
household/busi"n"ess'.) period shown on this receipt, bring the
:I part to any AutoZone store and you will
receive a replacement or refund.
Visit www.offlcedePot cum/feedback Illarranty .ezcludes damage caused, by
I misuse, abuse, other .faulty..perts,'• .
and 0 jO the-survey code below1 improper installation or off-road,
! :84XN.RVMH-VO.' commercial or na n ne use `Warranties on
j - ra016cement �Parts 'cover the unused '
.' ! portion of th6:origi,nal uerr.an:ty or
90 days, uhiehever is.;:longer: .,-
j Warranties exp.i,re when yod. sell your.
• :� vehicle.
THIS LIMITED. NARRANTY REPRESENTS THE
TOTAL LIABILITY OF,AUTO,ZONE; FOR ANY
PART:OR:PRODU.C.T. AUTOZONE MAKES.`NO
} OTHER WAR RANi,IES,:EX.PR.ESS:OR IMPLIED,
INCLUDI=NG THE.IMPLIED:;WARRANTIES.•OF
•MERCHANTABILITY OR FI°TNESS FOR A
PARTICULAR-PURPOSE.
AUTOZONE SHALL.NOT BE" LIABLE FOR
t ANY'INDIRECTr'_SPECIAL, -INCIDENTAL, OR
CLgO.MANAOEfl RYAN5SIMP`aN
CONSEQUENTIAL-DAMAGES.:
Some states dnot allow "lini.tations on
('317) 585'- 9619 how long. an "in'vIied warranty lasts, or
IAD)IAHAPOL'I.S;.I.N 1 exclusion or limitation on incidental or
11/17/17 13:27 5509 .0016$-•006 1683 i consequent,iaT damages so the'abbv'e
ARCTIC limitations may not apply toy.- you. This
rl uarranty`,gi:v.es you :specific I egal
** Dotton [if Basket Count 10 x***f9 rights,- and-vow. may:also have -other.
380857 BA0011/PAH 11.38 'T rights which -vary from=state_ 'to state.
794504 36.PK HICRO 15,96 T T a k e a survey f® r a
980060231 SANITI7ER 6.98 'T C h a n c.e t o w i n $5000
900060231 SANTCIZ{R 6.90 T
531335 SENTRYSAFE 189.90 T at www.autozonecares.com
454270 LYSOL.4 PAC 14.98 T or by calling 1-800-598-8943.
454270 LYSOL 4 PAC 14.90 T No Purchase ReeessarY. Ends 02/2'8/18;
995T86 STAPLLRPRBD 12.98 T subject to,Entry"Periods
10920 TAPE 6PK W/ 12:98 T Subikt•to fIl Official Rules
317895 02 PENSOLU 13.90 T at wwo.autoronecares:com.
* $ Dutton of Uas1et Count 10 * Ref. o - . -
SUOI.OTAL 301.10 ! Ofi�2 -91 9090 - 1-71213
TAX 1 7.000 .;3 . 21.00"
TOTAL 322.26 i
DEOIT TEND 322.26 F
CHARGE DUE, 0.00
EFT DEDIF PAY FROM PRIMARY
322.26 TOTAL PURCHASE
FIFTHTHIRO DERI1 x Wr *s** 8597 1 1
I&K Communications,Inc. IIIVOIC@
8212 Country Club Place h_ ;` -
Indianapolis,IN 46214-4302 t" r Number: 83748
Phone: (317)271-2050 =�
s"
Fax: (317)271-0046 Date: 11/30/2017
® �
c®mmunlcati®ns9 Inc. Source:SO No.212398
Bill-To Ship-To
Attn:Mike Aulby Attn: Mike Aulby
Ice at Center Green Ice at Center Green
10 Center Green 10 Center Green
Carmel, IN 46032 U.S.A. Carmel, IN 46032 U.S.A.
Acct.No. A/R Cust.No. Customer PO Reference Sales Ren Ship Via Terms
107987 Ice at Center Green Dan Shipley Net 30
Work Performed:
Qty. Item ID Description •
M Ea.Price Total-
5
5 TK-3402UK RADIO,HANDHELD 450-520 MHZ-UHF,5W. EA $271.00 $1,355.00 T
18 CHANNEL
5Sen'ai Numbers have been assigned
87716093 87716094 87716095 87716096
87716100
5.00 Programming Handheld-Indy Programming Handheld EA $0.00 $0.00
3.00 MISC HSS-K,Single Muff Headset w/boom mic and EA $44.00 $132.00 T
inline PTT
3.00 MISC EB1W-K:Earbud,one wire with K connector EA $26.00 $60.00
5.00 MISC KENWOOD EUR PROMO,INSTANT REBATE EA
($30.00) ($150.00)T
(Min.Qty of 5 Units)
Item Total: $1,397.00
Sales Tax at 7.000%: $97.79
Total Amount Due: $1,494.79
Please remit all payments to:
J&K Communications,Inc.
222 Towerview Dr.
Columbia City,IN 46725
j&k invoice indy.rpt Printed:12/4/2017 8:37:13AM
Page 1
CLUB MANAGER TRACY DANIEL See back of receipt for your chance
(y317 ) 871 - 7135 to win $1000
INDISNRPOLIS, IN
1/22/17 12:22 0076 06316 005 3355ID. #: 7L2TWZKBHF4
See back of receipt for your chance
:CTIC to win #1'000 --=-------------=- --
749706 MILKY WAY F 22.38 T ID #: 7L2TPMKBPPK
2442 KIT KAT BARF 20,59 N�
699366 GOLDFISH F 9.98 N - --- ------------ -----. -------- �- W� a �►t�;.
749276 SNICKERS F 27.66 T` �
698276 CHEEZ-ITS F 10,98 N ! Save money:Live better.
200863 RING POP F 12.72 T t
436012 FAST BREAK F 11.18 T Walmart
or LAFFY TAFFYF 7.28 T, ' ( 317 ) 894 = 0096
764198 VEGGIESTRAWF 12.68 Nie mons Live better. MANAGER KYLE LANGSTON
746674 3 MUSKETEERF 22.38 T y' 1 2001. E 151ST ST'
399374 HONEY BUN F 4.48 NCARMEL IN 46033
699366 GQLQFISH F 9.98 N ( 317 ) 844 - 0096 ST# 01601 OP# 008022 TE#''09 TR# 02589
764198 VEGGIESTRAWF 12.68 N1 MANAGER KYLE LANGSTON 2PK GLOVES 695334425787 1.50
2001 E 151ST ST 2PK GLOVES' 695338425788 1.50 H
980013241 CM SVRY SNCF 12.28 N CARMEL IN 46033 2PK GLOVES 695334425239. 1.60 i1
931469 AM 16CT HOTF 2.38 N ,
931469 AM 16CT HOTF 2.38 N ' ST# 01601 OP# 005424 TE# 12 -TR# 08616 2PK GLOVES 693732120198 1.50 X
931469 AM 16CT HOTF 2.38 NI 2PK GLOVES 695334425787 1 ,50 X I 2PK GLOVES 695334425239 1.50 X
931469 AM 16CT HOTF 2,38 N •2PK GLOVES 693732120198 1:50 X 2PK GLOVES 695334425788 1.50 X
931469 AM 16CT HOTF 2.38 N 1, 2PK GLOVES 695334425787 1 .50 X 2PK GLOVES .695334425242
1.60 X
2PK GLOVES 695334425230
931469 AM 16CT HOTF 2.38 N 2PK GLOVES 695334425787 1 .50 X 1.50 X
931469 AM 16CT HOTF 2.38 N ` 2PK GLOVES 693732120199 1.50 X i 2PK GLOVES -696334425230 ,1.50 X
931469 AM 16CT HOTF 2.38 NI '2PK GLOVES 693732120199 1.50 X 2PK GLOVES 693732120198 1,50 X
931469 AM 16CT HOTF 2.38 N 2PK GLOVES 693732120198 1 .50 X 2PK GLOVES 695334425242 1,60 X
2PK GLOVES 693732120199 1 .50 X 2PK GLOVES 695338425242 1.50 X
931469 AM 16CT HOTF 2.38 N '. 2PK GLOVES 695334425788 1.50 X 2PK GLOVES 695334425230 1,50 X
931469 AM 16CT HOTF 2.38 N
931469 AM 16CT HOTF 2PK GLOVES 693732120198 1 .50 X 2PK GLOVES 695334425788 1.50 X
2.38 N
931469 AM 16CT HOTF 2.38 N 2PK GLOVES 693732120198 1.50 X 2PK GLOVES 695334425230_ 1 ,50 X
931469 AM 16CT HOTF 2.38 N 2PK GLOVES 695334425788 1 .50 X 2PK GLOVES 696339925234 1.60 X
931469 AM 16CT HOTF 2.38 N 2PK GLOVES , 693732120198 1 .50 X 2PK GLOVES 696334425230 1.60 X
931469 AM 16CT HOTF 2.38 N 2PK GLOVES 693732120199 1 .50 X 2PK.GLOVES 693732120198 1.50 X
931469 AM 16CT HOTF 2.36 N SUBTOTAL 21.00 2PK GLOVES 696334425787 1:60 X
931469 AM 16CT HOTF 2.38 N , TAX 1 7.000 % 1.47 2PK GLOVES 695334425788 1.50 X
TOTAL 22.47 2PK GLOVES 696334426788 1160 X
931469 RM 16CT HOTF 2.38 N DEBIT TEND 22.47 f 2PK GLOVES 695334425788 1,50 X
931469 AM 16CT HOTF 2.38 N CHANGE DUE 0.00 2PK GLOVES 696334425230', 1 .60 X
779917 MUNCHIES F 9.98 N i 2PK GLOVES 695334425788 `1.50 X
55272 FLAMIN HOT F 10,98 N 2PK GLOVES 695334425788
749278 SNICKERS F 27.56 T 1.50 X
887285 SKTBRIGHTSDF 14.64 T EFT DEBIT` PAY FROM PRIMARY 2P,K GLOVES 696334425788 "1.50 X
16017 STRBRST ORIF 21 .98 T-i 22.47 TOTAL.PURCHASE 2PK GLOVES 696334425787 ; 1.60 X
706387 18CT XTREMEF 9,98 T i US DEBIT * ** ***'� # ** 6993 ,I 3 2PK GLOVES 693732120198 1.50.X
705387 18CT XTREMEF 9.98 T REF # 732100631023 i 2PK GLOVES 695334425242 1:50 X
706387 18CT XTREMEF 9.98 T NETWORK ID. 0081 APPR -CODE 131477 2PK GLOVES 696334425230 1.50 X
2PK GLOVES 693732120198
705387 18CT XTREMEF 9.98 T 1.50 X .
705387 18CT XTREMEF 9.98 T US DEBIT 2PK GLOVES. 696339425787 , ' . . 1.50 X
674152 SOURPATCHKIF 13.68 T AID A0000000980840 2PK GLOVES 693732120199 1,60 X
763260 PAPER PLATE 15.78 T TC 4532685E7A9A5555 2PK GLOVES 695334425242 .1.50 X
980037572 MM CARAMEL F 14.98 T *Pin Verified 2PK GLOVES - 695334425234 1,60 X
328189 TWIXCARAMELF 20.68 N TERMINAL # MX569680 2PK GLOVES 696334425242 11,60 X
710754 HOTHANDS 14.98 T 12PK GLOVES 696334426230 1.60 X
710754 HOTHANDS 14.98 T ' 11/17/17 11 :14:23 2PK-GLOVES 693732120199-
710764 HOTHANDS 19.98 T ' # ITEMS SOLD 14 2PK GLOVES 695334425233 . 1,60 X
710764 HOTHANDS - 14.98 T TC# 8134 1138 6411 6609 3138 2PK GLOVES 696334426234 1.50 X
710764 HOTHANDS 14.98 T 2PK•GLOUES 693732120199 1 50 X
710754 HOTHANDS 14.98 T 1111111
II ZPK GLOVES 693732120198 1.50 X
710754 HOTHANDS 14.98 T 2PK GLOVES 696334426242
710764 HOTHANDS 14.98 T Low Prices You Can Trust, Evers Day. 2PK GLOVES 693732120199 1.50 X
192278 MM BEEFFRANF 23.98 N 11/17/17 11:14`28 2PK GLOVES 695334425233 1.50 X
1.
192278 MM BEEFFRANF 23.98 N Use Walmart Pay to save your receipts. 2PK GLOVES 695334425233 50 X
192278 MM BEEFFRANF 23.98 N 2PK GLOVES 695334425234 1.50 X
192278 MM BEEFFRANF 23.98 N 2PK GLOVES 693732120198 1.60 X
192278 MM BEEFFRANF 23.98 N 2PK GLOVES 693732120198 1.60 K
399174 NESQUIK CHOF 9.98 N SUBTOTAL 76.00
399174 NESQUIK CHOF 9.98 N TAX 1 7,000 % 6.25
399174 NESQUIK CHOF 9.98 N TOTAL 80.26
440965 DRUM LINER 21.54 T DEBIT. TEND 80,25
440966 DRUM LINER 21 .64 T CHANGE DUE 0,00
925464 RANCH DR F 6.98 N
898535 SWT BBY RYSF 9.70 N
435961 CHI CHI SALF 3.98 N I EFT DEBIT PRY FROM PRIMARY
436961 CHI CHI SALF 3.98 N 80,25 TOTAL PURCHASE'
794504 36 PK MICRO 15.96 T - US DEBIT **** **** **** 6993 I, 3
912037 COMFORT MAT 19.87 T REF # 732300211812
912037 COMFORT MAT 19.87 T ` NETWORK ID. 0090 APPA CODE 512443
SUBTOTAL 838.01
TRX 1 7.000 % 33.64 US DEBIT
TOTAL 871.65 AID AOOO0000980840
TIDED BANKCARD TRANSACTION ± TC 85C715BBF9A25EF4
[FTHTHIRD DEBIT * **** **** 8597 I 1 I *Pin Verified
[D 80000000042203
RMINAL # SCO10852 TERMINAL # MX610292
:
CUSTOMER CANCELLED BANKCARD 11/19/17 16:64:22 '
11/22/17 12:28:33 # ITEMS SOLD 60
DEBIT TEND 871 ,65 TC# 8071 4723 0264 9362 8465
CHANGE DUE 0.00 � ��•; III�IIIII�II�IIIIUIIIIIIIIIIIIIIIIIiIIfIIIIIIIIIIIIiiIIIIIIIIIIIIIIIIIIIIIIIIIII��►�I���►
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11724/2'017`11-2-'18'PM EXPIRES 02/22/18
, /'INDIANAPOLIS' (31 T) 578 8001
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002110514 WALL HOOK T -$q 99: 4 VIII I IIIIIIII III I III IIIIII IIIIIIIIII I IIII IIIIIIIIIII IIII ,:,;, f..
245000184_ CNTR BAR'ST0 T $19 98y r;., , s2PTTYRPP,Q355B6RWW
.. 2` -JJ.
24y000276. FOLDING,T13L
SALE" '' •.r 6323 1=8927 286546 1'7.8.2"
z t t -SUBTOTAL $53 96; 755858 LIVESRFE 17 RT j 14.
9'99
T IN TAX 7 0000 on $53 96 $3 78 Proigot'ion' ` s r`' 89 99
, z TOTAL $57-74 ., nr t
16
You Paw 0 OOf=
*8597 DEBIT TOTRL PAYMENT
$57.74 EMP ID 286646
AID" ,A0000000042203 ," 1 +s :
75615.1 TCKT..,:RL,DB ,
ut 7t,C99 t,T , i �'.i
t 2 @ 10 21
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Storewide Purchase Courson 411/28-12/10
� 186,07 e�D,icortso,.lsx2
REC#2-7328 1063-0084 6185-2 VCD#758-286-945 `,ou Raw t 24 99'
73861`8 MRKR `DRY,
El ctrAni 6s recychi ng I n ormatison: ' 840508` "BrjG;UNYL ZIP,3 14 99'S
ht tp://www ,i n.gov/i;deitl/recycd`e/2377,htm
57784$' 8D;'D ,lK,SUR,1
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- - Subtotal 83 .44
----- ---- -- -- ---------- ------ Sales Tax; 5.84
j f Total 89.28
i Debit Card 8597: 89.28
Foedbac TAS Chip Read
Leif it for US
AID A000000,0092203; -FIFTH
_DEahT
TVR 0000098000
' CVS PIN Verified
Help make your Target Run better. CARMER ICL ST RDI UM`t829393611' '
Take a 2 minute surv44y about today's trip: " Please r,create your online rewardss
' i Q i1�tt ,.r..r„F Eu
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User ID: 7267:;1893 7991
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< CUT HERE
WE WANT,
TO HEAR FROM+YOU�
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P,articiPate tn�our online pustomer ,
survey'randr receive a `coupon fors
offwour---'nexti,'aual=tflahs # =F
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j office supplles, furniture and more.
• Excludes Technolosy Limitsl coupon Per
household/business )
Your tleket to gift perfection..4;,
To Visit www,.offtcedepot:.,com/feedback
and enter the survey. code below
From: rii 1 OK 9EVM 46FR
. :11724/20.17 ,
fr. '•„IIIIILI IIII�III III I I-.I III II VIII III .,_ , _
S
I
i ICA-
CLUB MANAGER, RYAN SIHPSON
( 317 ),585 - 1519
IND IAHAPOLIS. IN
11/24/17 09:40 0120 =06168 008 1860
ARCTIC
N812214 QR 09ID170,• -9-9.O.J
55,Q98'1 3PKCL�IPBOAR; -: • 6 48 T--�;
"550.961 3PKGL:"IPBOAA40"T..'
9643,1 HMtlR`%TTNBPA. . 6 98 T
853,111 FIRRSr AID
85311=1 FIRRST APD 24 90 T.
N 65311.1 FIARST AIB 24 98
300508 MM ;GLOUE'S 9 93 T
454270 LYSOL 4 PAC 1'4 98 T,..
45427.0 LYSOL 4 PAC 14 98'T
980047066 KAKItCHERNA . 29 98 T_
98004'7:06'.6 KAK_ITCHENHA'- 29 9'0,.T_,
SUBTOTAL 214.69
tTAX 1 73601 15.03
TOTAL 229.72
DEBIT TEND 229.72 i
CHANGE DOE 0.00
EFT DEBIT PAY FROM PRINARY
229.72 TOTAL PURCHASE
FIFTBTHIRD DEBIT * *0* **0 8597 I 1
NETWORK ID. 0076 APPR CODE 111576
fDebit .
AID ROOD0000042203
T560FOROD5E7793E4
*Pir�`9erified
( TEHNINOL A SCO10655
r
Uisit samsclub.com to see Your savings
ITEMS SOLD 13
TC# 6938 0788 7699 9100 1335 7
. � IIIIIILIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111011111ilIIIIIDIIIIIIIiilllllllilllllllllllll
HAPPY to H01P
APLES
I
8245 East 96th Street
Indianapolis INA6256, .
•(317) 913-;1:669.:;
SALE 1699231 2. 002 01085
.0809 11/17/17 02;11
Your Sales Associate was,
Juliann G.
QTY- SKU PRICE
2 WASTE 28QT BLACK P
718103167956 7.790ea 15.58
1 ,STAPLE8'":13GAL DPW—
:718103276931. .,
RAW'718103276931 7.99
1 RECYCLEQ 12XTICKE
718103130158 10,79
1 BIC RND STIC GRP H
070330139022 2.00 !
i1 BIC RND STIC GRP,B :
070.330139022 , 2,00
LSUBTOTAL ; 38;36,
., ,.Standard Tax. 7.00% 2.69
`'T(l1AL $41 .05
IFIHTHZ'RD DEBI? USQ$41.05
Card No; XXXXXXXXXXX8597 '[G]•
Ch'i
• 'Ankh No, 230841
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I
1 •
*It6w is-cur'rent 19 on,promotion, Some ';,mY
cpupon's,'are only valid on 'regular priced
items, Please see coupon terms and
conditions for 'details.
Staples brand products.
Below Budget. Above; Expectations.
THANK YOU FOR SHOPPING AT STAPLES !
Shop online .at www,staples..com
Shop Smarter:-Get Rewarded.
Staples Reards membersget up to 5%
back in Rewa6 sin store :onl'y. $2 back in
Rewards per recy6jbd°ink cartridges. Up to
20 per month.Minimum purchase required.
Exclusions Apply,See an associate for
full program details or to enroll .
Use Your 2°,6 Use Your 2.%
( BIG CARD REBATE BIG_CARD REBATE -
MENARDS - CARMEL MENARDS . -`°,CARMEL
2150 E . Greyhound 2150 ' E . Greyhound j
Pass Pass
Carmel , IN 46033 Carmel , IN 46033
KEEP YOUR RECEIPT KEEP YOUR RECEIPT
RETURN POLICY VARIES BY PRODUCT TYPE RETURN POLICY VARIES'BY PRODUCT TYPE
Unless noted below allowable returns for '" Unless noted below allowable returns for
items on this receipt will be in the-form items on this receipt will be in the form
of an-in storecredit voucher`if the of an in store credit voucher if the
return is done after 02/15/18 return is done after 02/17/18
If you have questions regarding the If you have questions regarding the
charges on your receipt, please charges on your receipt, please
email us at: email us at:
CARMfrontend9menards.com CARMfrontend9menards,com
� 1111111 IIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIillilillllllllllilllllllllllllllill
Sale Transaction Sale Transaction
30 PK TUBULAR HANGERS 16.QT STACKING DRAWER
6442609 3.48 16452223 2 96.44 12.88
DUAL ROD EXP GARMENT RAC I WINTER IMPACT PRO GLOVE
2119843 19.99 6605725 2 929.99 59.98
DURACELL ALK. AAA-4 PK WINTER IMPACT PRO GLOVE
I 5755755 3.99 6605726 29.99
40MM ALUMINUM LOCK 4 PK 3-1/4' SAFETY HASP - ZIN
j 2199826 3.00 P 917.99/PKG 53.97 2251239 7 92.57 17.99
15 QT CLEARVIEW LATCH BO 3' ' BARREL BOLT - ZINC
6452295 2 93.97 7.94 2254210 2.47
16 QT STACKING DRAWER. 2-1/2'' BARREL BOLT - ZI
5452223 4 96.44 25.76 2254207 2 91.95 3.90
` BOY GAUNTLET GLOVE
TOTAL 115.13 6603140 2 94.99 9.98
TAX STATE OF IN 7% 8.06 18" STD BUNGEE 1PK-RED
TOTAL SALE 123.19 2356512 4 91.25 5.00
FIFTHTHIRD DEBIT 8597 _ 123.19 j
EFT Debit' 11/17/17 20:34:19 TOTAL 142.19
Ref# 203411171042 PRIMARY ACCT TAX STATE OF IN 7% 9.95
IChip Inserted 1: TOTAL SALE 152.14
a0000000042203 FIFTHTHIRD DEBIT 8597 152.14
TC - 3c6109e157167700 EFT Debit 11/19/17 11:30:09
f Ref# 113011191042 PRIMARY ACCT
TOTAL SAVINGS 6.00 i Chip Inserted
! a0000000042203
TOTAL NUMBER OF ITEMS = 12 TC - 96f2b5926a2fbbe2
7
TOTAL SAVINGS 10.00
NOW HIRING TOTAL NUMBER OF ITEMS = 21
THANK YOU, YOUR CASHIER, Sarah
64996 02 8381 11/17/17 08:33PM 3083 0 HIRING
THANK YOU, YOUR CASHIER, Morgan
65161 07 2063 11/19/17 11:29AM 3083
Becker-kena Products.inc Phone: : .. 800-234-5522.
720 Innovation Drive. Fax#: 952-890-2680
— Shakopee MN 55379 USA www:beckerarena.com
ARENA PRODUCTS,INC. '..
Invoice: 101,0880- . INVOICE • - Page: 1 of 1
.Date::: . : . '11/22/2017
Sold To: CAR002 Ship To:.
Floyd.Johanson . .
Floyd Johnson
Carmel Ice Skadium. . Carmel Ice Skadium
.1040 3rd Ave.S.W. : .
- 1040 3rd Ave:S
Carmel 1N 46032_USA Carmel IN.46032 USA .
Fax: (317).844-8889 ' . EMail:floydj@carmelice.com
PO Number: Center Green Terms:NET 30 SO#: 1008212
im -
Sales Rep:-Dari Evans, Ordered: 11/8/201712:00:(:; . Ship Via:
Sales Tax ID Ship Date:. 11/222017
Llne Part Number/Description_ ity `-Unit Price —Ext Price
.1 38.10305: - . 400.00'SF 2:30000 /1 920.00
REGUPOL FLOORING:-SOLID BLACK . PO Number., Center Green
SF Reference:
Our Part:.38.10305
,.
ro s . x �,
Miscellaneous Charges
Description Amount
1:) Freight-'Out 240.00
Invoice :Taxes-
Line Taxable Amt Percent Amount
1 1,160.00 7.00%_ 81.20
i Payment Schedule
Due Date' Amount
- 1---12/22/2017 -_ 1,241,20 Total: 1;241.20
Total _- - 124120]
AR Form:ARForm_. " .
AmeriGas-5865
_
—524 S Berkely Rd
Kokomo IN 46901
InvoiceAnwiQn.
800-797-7731
www.ameri as.com
Page 1 of
ACCOUNT NUMBER: 201478216 INVOICE NO: 3071456276 INVOICE DATE: 11/22/2017
INVOICE AMT DUE: $245.82 NAME: THE ICE AT CENTER GREEN
DUE DATE: 12/22/2017 SERVICE ADDRESS: 1.040 3RD AVE SW
CARMEL IN 46032-2524
Previous Balance Payments Adjustments/Credits New Charges Account Balance Due t'IriVotce,Amount Due
$1,714.49 -$247.23 $0.00 $245.82 $1,713.08
Account Activity
Date Ref No. Description Quantity Price Amoui
11/21/17 623820713 Propane 56.0 $3.809/GAL $213.3
SITE:103599607
HazMat Fee-T $10.9
Fuel Recovery Fee-T $5.4
State Sales Tax $16.0
TOTAL NEW CHARGES $245.8
Account Balance Due includes all outstanding charges for which we have not received payment and may not reflect payments
sent.
MESSAGES
Your safety is our priority! For helpful tips for a worry-free winter,visit the Propane/Consumer Safety section of our company
website.
We periodically review and revise our standard Terms&Conditions.Visit our company website to read the T&C that apply.
Earn$100 for new residential customer referrals and$150 when you refer a new business.Visit our company website to learn
how.
Q Contact Us:Billing,Service&Delivery: 800-797-7731
® Pay Online or Enroll in our Automatic Payment program: www.amerigas.com
THANK YOU FOR YOUR BUSINESS!
---------------------------------------------------------------------------------- - - -- - - -------------------------------------------------------------------------------------------------
Account No. Invoice No. Invoice Date Due Date Amount Du
201478216 307145627611/22/2017 12/22/2017 $245.8
AMERIGAS-5865
624 S BERKELY RD TOTAL AMOUNT ENCLOSED $
KOKOMO IN 46901
Please return this portion with your payment
Account or user address change?
If yes,please check box and complete reverse side.
2757 1 MB 0.423 E0066X 10154 D3060637225 S2 P4843293 0001:0001 H1
ARCTIC ZONE LLC REMIT TO
1040 3RD AVE SW DEPT 0140
CARMEL IN 46032-2524 PALATINE IL 60055-0140
0201478216000307145627600000000245824
0001:0001
EMEBIT B
Invoice
Name of Company: l�� o�''�' Date:
Address&Zip: /a q°
Telephone No.:
3 17 -
Fax No..
Project Name: /e e- ar (e
Invoice No. 00s l
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
GRAND TOTAL
Signature
Printed Name
111111111111111111111111111111111111 IN Page 1 of 1
Runyoly 410 West Carmel Drive Status: Closed
EQUIPMENT RENTAL Carmel,IN 46032 Invoice Date: Fri 11/17/2017
Invoice#: 456005-1
www.runyonrental.com Date Out: Fri 11/17/2017 7:52AM
1-800-276-Tool(8665) 317-566-8888 Phone
"Don't be a tool-Rent one" 317-566-2990 Fax
Operator: Tim Church
Customer#: 2171 Terms: On Account
CARMEL ICE SKADIUM 317-844-8889 Phone
317-8463254 Fax
1040 3RD AVE.S.W.
CARMEL,IN 46032 PO#: CENTER GREEN
Open Monday-Friday 7:00am-5:30pm,Saturday 7:00am-4:30pm,Sunday 9:00am-3:00pm
Picked up by:JOHNSON, FLOYD D
Salesman: NONE
Qty Key Items Returned Date Status Each Price
1 761475960632-1 SQUEEGEE 36"W/HANDLE 4136 Pulled $29.99 $29.99
1 C-60-1 HANDLE 1 1/8X60"TAPERED C-60 Pulled $4.25 $4.25
1 079617782029-1 SCRAPER 6"WOOD RAZORBACK Pulled $28.99 $28.99
1 C-60-1 HANDLE 1 1/8X60"TAPERED C-60 Pulled $4.25 $4.25
1 079617531306-1 SHOVEL SCOOP ALUMINUM D-HA Pulled $43.99 $43.99
1 055636806557-1 SNOW SHOVEL PUSHER ALUM 24 Pulled $34.99 $34.99
Thank You for your Business
Rental Contract
You understand that:(a)it is unauthorized for me to lend the Rented Item(s)to any other person;(b)THE RENTED ITEM(S)
WARE FULL OF FUEL AND MUST BE RETURNED AS SUCH OR ADDITIONAL CHARGES WILL APPLY(c)use of alternative
fuels(e.g.Biodiesel,E85,etc.)in Rented ltem(s)is prohibited and you are responsible for all damages and repairs resulting from Sales: $146.46
alternative fuel;(d)no electrical tools are supplied with safety grounded plugs for use in grounded outlets(except for
doubleansulated safety-approved tools),and you are responsible for not cutting off the ground lug;(d)Runyon is authorized to
charge my debit or credit card for all amounts coming due hereunder,including for damage to the Rented Item(s)which is
discovered after the Rented Item(s)have been returned;and(e)labor rate is charged at$85.00 per hour. X (Initial)
I have been instructed and demonstrated on the safe and proper operation of the above equipment,and I fully understand those
instructions. X (Initial)
I have provided Runyon with proof of insurance(insurance that covers all damage to or loss of Equipment)and am declining the Subtotal: $146.46
Equipment Protection Plan(Damage Waiver)as described on the back of this ContracLx (Initial)
The undersigned has carefully read and fully understands the Terms and Conditions on the back of this Contract and personally
guarantees the Customer's prompt payment and performance of its obligations arising under this Contract. Indiana Sales Tax
Printed Name: $10.25
Total: $156.71
Paid: $0.00
Signature:
JOHNSON,FLOYD D Amount Due: $156.71
EXHIBIT B
Invoice
Name of Company: /4
c;Fic 7o.,I, Date: //1 /'7
Address &Zip: /0 /o 3Ad axuc
Telephone No.: 31-7
t-7-
Fax No.:
Project Name: lee- a.,T' �el,-e,__ 62ze_^J
Invoice No.
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
�pcl� ti �,✓ /ems L �a
IA-,e.,V4
840 O'
GRAND TOTAL
Signature
/",,/ems
Printed Name
Becker Arena Products Inc Phone: 800-234-5522
720 Innovation Drive Fax#: 952-890-2680
Shakopee MN 55379 USA
.. www.beckerarena.com
ARENA PRODUCTS,INC.
Invoice: 1010218 ( 'IN1/OICE Page: 1 of 1
Date: 10/19/2017
Sold To: CAR002 Ship To:
Floyd Johnson 6 Floyd Johnson
Carmel Ice Skadium
Ie,
Carmel H 4" -) Carmel Ice Skadium
1040 3rd Ave. S.W 1040 3rd Ave. S.W
Carmel IN 46032 USA Carmel IN 46032 USA
Fax: (317)844-8889 Entail:floydj@carmelice_com
_ PO Number. Verbal per Floyd Terms: NET 30 -� _ SO#: 1007800
' Sales Rep: Greg Reese Ordered: 10/11/2017 12:00: Ship Via: Best Way !
Sales Tax ID: Ship Date: 10/16/2017 s
Line Part Number/Des"c"nptron" qu`an"tity
nit U Pnce Ext P��ce
1 42.10170 256.00 SF 3.35000 /1 857.60
ULTIMATE VINYL IN ICE GRAPHICS PO Number. Verbal per Floyd
SF Reference:
Our Part. 42.10170
Miscellaneous Charges
Descriution Amount
1.) Freight-Out 48.96
Invoice -Taxes-
Line Taxable Amt Percent Amount
1 906.56 7.00% 63.46
fRPavmentSchetlule -.
I DueDate _ _y Amount
1 11/18/2017 970.02 Total: 970.02
Total 970.02:`
AR Form:ARForm '
EXHIBIT B
Invoice
Date: c
Name of Company: ,��T.� ��"�Q ��
/o �D 3Ad �_
Address Fd Zip: C,-km-e-li �bo3t
Telephone No.:
Fax No..
Project Name: �E 2 aI' �.� ��e,,.i
Invoice No.
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
117
GRAND TOTAL
Signature
Printed Name
Order Status Page 1 of 1
TOTALLY
For any questions about your order please call our toll free numbers 1-866-847-4580 or via email at customerservice()totallvfumiture.com.
Please have your order number ready for faster service.
Thank you and have a wonderful day,Totally Furniture Team
If you have any questions about your order,please Contact Us
Shopping Cart
Item---------_--
Unit , Qty. Cost
i Price
5-Door Metal Storage Locker Cabinet with Key Lock Entry-Diamond Sofa LB5BU(Shipping j $239.00 8 $1,912.00
Included)
I
Subtotal:I $1,912.00
Shipping:1 $0.001
Tax: $0.00
Total:i $1,912.00 i
Order Status
Confirmation
Order Status:
Tracking:
Order Date: 11/03/2017
Order Number: totallyfumiture-86720
Ship To
Michael Aulby
Carmel
1040 3rd Ave.SW
Carmel,IN 46032
317-431-0187
Bill To
Michael Aulby
Arctic Zone
1040 3rd Ave.SW
Carmel,IN 46032
, 3178448889
! maabl02@aol.com
Keep Shopping
Privacy Policy Merchant's Privacy Policy
httt)s://order.store.vahoo.net/OS/stat9totallvf lmiture+96720+7adf6OO2feCR757-1hh1 h 1 I/21/2017
order totallyf n-niture-86720 from Furniture, Furniture Store, Furniture Accessories,Bedr... Page 1 of 2
From: Furniture, Furniture Store, Furniture Accessories, Bedroom, Bathroom, Kitchen, Furniture Accessories,
Bedroom, Bathroom, Kitchen<info@totallyfumiture.com>
To: Michael Aulby<maab102@aol.com>
Subject: order totallyfumiture-86720 from Furniture, Furniture Store, Furniture Accessories, Bedroom, Bathroom, Kitchen
Date: Fri, Nov 3,2017 2:48 pm
This email is to confirm the receipt of your recent order with Totally Furniture.
We appreciate your business and would be happy to assist you with any additional questions you
might have.
For your convenience we are available Mon-Fri 9 Am- 5 Pm EST(Florida time)by calling 407-848-
5000.
Please do not use the below Yahoo tracking link below, it will not reflect your order status. We will
email your order updates via email instead.
You can always see your order by going to
httys://order.store.yahoo.net/OS/stat?t6tallyf n-niture+86720+7adf6002fec87573bb1b
Date Fri Nov 3 14:48:37 EDT 2017
Ship to Michael Aulby
Carmel
1040 3rd Ave. SW
Carmel IN 46032
US United States
317-431-0187
Bill to Michael Aulby
Arctic Zone
1040 3rd Ave. SW
Carmel IN 46032
US United States
3178448889
E-Mail maab 1 02aaol.com(emailed)
NewsLetter no
TermsandConditions yes
Payment MasterCard
Name Code Qty Each Options
----------------------------------------------------------------------
5-Door Metal Storage Diamond-LB5BU 8 239.00
Locker Cabinet with Key
Lock Entry -Diamond Sofa
LB5BU(Shipping Included)
Subtotal 1912.00
Shipping 0.00
Tax 0.00
Total 1912.00
https://mail.a'ol.com/webmail-std/en-us/PrintMessaae I 1/91/2017
UGHBIT B
Invoice
Name of Company: �,:,�T� ZoNe-
®ate: ✓� ����
Address &Zip: /d �,o
Telephone No.:
Fax No.:
31-7-
Project Name: 1,Ce ���T ��ez•✓
Invoice No. '70.2 0
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
Con�Q��
�7T een�
C'ati��,tr /�x � (e, e� Gti ��.• •�_ p
GRAND TOTAL
347.6(
Signature
Printed Name
fu :
CORPORATE
Customer •
IMAGING
CONCEPTS
0: Northbrook, .00. .00 . .
.' ..: ... .
' Sold To: Mike Aulby Ship To: Mike Aulby
Carmel Ice Skadium Corporate Imaging Concepts
1040 3rd Avenue S.W. , 12388 Hancock Street
Carmel, Indiana 46032 Carmel, Indiana 46032
Invoice Number 702041-01 Invoice Date i 11/20/2017
Order Number 702041 Invoice Due Date 12/20/2017
Customer Name : Carmel Ice Skadium Customers P/O Number -
Customer Number 995577 Ship Date -
Item# Description Ordered Shipped Unit Sell Extended Price
1799_44720_2 Black/5- Port Authority Heavyweight Parka.
1799 1 1 $100.05 $100.05
1799_44720_3 Black/M- Port Authority Heavyweight Parka.
' J799 1 ' 1 $100.05 ' $100.05 :
J799 44720_4 , Black/L- Port Authority Heavyweight Parka.
1799 2 2 , $100.05 ; $200.10 :
J799_44720_5 Black/XL- Port Authority Heavyweight Parka.
1799 1 : 1. $100.05 $100.05
J332101212 2
Black/Black/S- Port Authority Vortex
Waterproof 3-in-1 Jacket.1332 3 . 3 $92.09 $276.27 :
1332_101212_3 Black/Black/M- Port Authority Vortex
Waterproof 3-in-1 Jacket.J332 6 6 $92.09 $552.54 ,
1332_101212 4 Black/Black/L- Port Authority Vortex
Waterproof 3-in-1 Jacket.J332 4 ; 4 $92.09 ' $368.36
J332 101212_5 Black/Black/XL- Port Authority Vortex
Waterproof 3-in-1 Jacket.J332 3 3 . $92.09 $276.27
J332 101213 1 . Black/Black/2XL- Port Authority Vortex
Waterproof 3-in-1 Jacket.J332 1 1 '. $93.45 $93.45
1-332_101192_ Black/Black/S- Port Authority Ladies Vortex
2 Waterproof 3-in-1 Jacket. L332 5 5 . $92.09 $460.45
L332_101192_ Black/Black/M- Port Authority Ladies Vortex
3 Waterproof 3-in-1 Jacket. L332 3 3 $92.09 $276.27
L332_101192_ ` Black/Black/L- Port Authority Ladies Vortex
4 Waterproof 3-in-1 Jacket. L332 2 2 : $92.09 $184.18
CP90_17660_3 ' Black/OSFA- Port&Company-Knit Cap. CP90 20 20 $8.65 $173.00
1_0_0_0_0_0_ - Digitize The Ice At Center Green logo 1 1 $68.00 $68.00
0 0 0
Subtotal $3,229.04
Shipping ; $29.85 ,
Sales tax $228.12
Total $3,487.01
Payments $0.00 '
Terms:NET 30 Amount due r $3,487.01
Order Confirmation-Wristband Express https://www.wristbandexpress.com/checkout/confirmation?id=8a67'
a
Home > Order Confirmation
i
1
Order CompleteiL-,- L C'� �"
A confirmation email has been sent to you with the details of your order. Receipt-
Order #6383085
i
1
Bill to: Ship to: Order #:
Michael Aulby Floyd Johnson 6383085
1040 #rd Ave SW 1040 3RD AVE SW Order Date:
Carmel, IN 46032 CARMEL, IN 46032-2524 11/10/2017 j
+ maab102@aol.com Status: A
�
Open
Name Qty Price Ext.
i
3/4" Tyvek@ Wristbands Solids (Neon Blue) 2 $14.95 $29.90
I
#T3VL-05-0 i
Wristbands per Box: 500
3/4" Tyvek@ Wristbands Solids (Neon Green) 2 $14.95 $29.90
j #T3VL-01-Q
Wristbands per Box: 500
3/4" Tyvek@ Wristbands Solids (Neon Orange) 2 $14.95 $29.90
#T3VL-04-Q �
Wristbands per Box: 500 I
3/4" Tyvek@ Wristbands Solids (Neon Red) 2 $14.95 $29.90
! #T3VL-03-Q
Wristbands per Box: 500
3/4" Tyvek@ Wristbands Solids (Neon Yellow) 2 $14.95 $29.90
#T3VL-02-Q
f
Wristbands per Box: 500
Tyvek Setup 1 $45.00 $45.00
#FEE-PLATE-QP
Wristbands per Box: 1
i
Subtotal: $194.50
1 of 2 11/10/2017,4:03 P1
Order Confirmation-Wristband Express https://www.wristbandexpress.com/cheekout/confirmation?id=8a67
Discount: $0.00
Shipping: $13.58
Sales Tax Ml): $0.00
Order Total:
$208.08 1
2 of 2 11/10/2017,4:03 R
EXHIBIT B
Invoice
Name of Company. 1 C ` Date: /XC 4-1
Address &Zip: C,fx-m e/!
Telephone No.: 3,-,. F tl 6_
Fax No..
Project Naive: lee- a.,?- d2,.
Invoice No.
Purchase Order No: �3�.�D s.s'
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
f�q,12 e,',Al ems ¢SSio N�
h
GRAND TOTAL
Signature
Printed Name
Fwd: Wristband Express Order#6385544 Page 1 of 2
From:maab102<maab102@aol.com>
To:Mike Aulby<maab102@aol.com>
Subject,Fwd:Wristband Express Order#6385544
Date:Sun,Dec 3,2017 2:13 pm
Sent from my iPad
Begin forwarded message:
From:"Wristband Express"<info n�wristbandexoress com>
Date:November 28,2017 at 3:10:39 PM EST
To:maab102Ccr�,aol.com
Subject:Wristband Express Order#6385544
Wfismand
EXPRESS ORDER CONFIRMATION
Dear Mike,
Thank you for ordering from Wristband Express.Your order has been received and is currently being processed.You
will receive a shipping notification with your tracking number once your order ships.
If you need to contact us regarding this order,please e-mail us at infoowristbandexoress com or call us at 1-800434
9124(International:+1-262-3731903).
•Click here to View Current Order Status
•Click here to Place Another Order
Purchasing Information
Order Number: 6385544
Order Entered: 11/28/2017 8:09:29 PM
Shipping Method: 2nd Day Air
Payment: Credit Card
Bill To _ Ship To
Mike Aulby Mike Aulby
Carmeliceskadium Carmeliceskadlum
1040 3RD AVE SW 1040 3RD AVE SW
CARMEL,Indiana 46032-2524 CARMEL,Indiana 46032-2524
USA USA
Order Information
QuantityWristbandsPart# Item Description Unit Extended
Price -., Price
4 2000 T3VL-05-Q 3/4"Tyvek@ Wristbands Solids(Neon Blue) $12.95 $51.80
4 2000 T3VL-OS-Q 3/4"Tyvek@ Wristbands Solids(Neon Green) $12.95 $51.80
4 2000 T3VL-04-Q 3/4"Tyvek@ Wristbands Solids(Neon $12.95 $51.80
Orange)
4 2000 T3VL-03-Q 3/4"Tyvek@ Wristbands Solids(Neon Red) $12.95 $51.80
4 2000 T3VL-02-Q 3/4"Tyvek@ Wristbands Solids(Neon Yellow) $12.95 $51.80
1 FEE-PLATE- Tyvek Setup $45.00 $45.00
QP
Subtotal: $304.00
Coupon Discount: $0.00
Shipping: $21.90
Sales Tax: $0.00
Order Total: 5325.90
<-> The Ice At Genter G een
https://mail.aol.com/webmail-std/en-us/PrintMessaLe
EXHIBIT B
Invoice
Name of Company:
Date: 1112 t
t !r� A,
Address &Zip:
Telephone No.:
Fax No..
Project Name: Ae d-4- dxZ-27,- 4 �&e J
Invoice No.
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
/oma
mak
l0,voo
GRAND TOTAL
Signature
Printed Name '
EXHIBIT B
Invoice
Name of company: Ar �o.,ve- Date: %//.Z t /1,-7
Address &Zip: 1
Telephone No.:
Fax No.:
Project Name:
InvoiceNo.
Purchase Order No: zIs1l
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
GRAND TOTAL
�G
Signature
Printed Name